Balancing Patients confidentiality with national interest & security

Mon, 21 Apr 2008 Source: Agyepong, Benjamin Opoku

Many practitioners within the health industry as well as some politicians have called for nurses and doctors to safeguard patients’ records and ensure patients – practitioners’ confidentiality. It is; therefore, no wonder that when Mrs Makafui had the opportunity to address student-nurses and other health workers in Winneba on April 18th, she chose to echo those sentiments. She would not have had any better forum than that, a forum attended by over 600 student- nurses and health workers.

It sound ethical to adhere to strict patients- practitioners confidentiality, but in the face of the ravaging AIDS epidemic and the attitude of some HIV-AIDS patients, who care less about the rest of the population when they discover that they are infected, and would like to take everybody with them to the grave, shouldn’t we balance ethics with pragmatism? To ensure that, the larger national interest is protected by adopting any means necessary to reduce infection which includes revealing to the public, the identity of those infected, thereby, reducing the spread of this epidemic which threatens national security rather than adhere to strict ethics of patient confidentiality?

Mrs. Makafui said “health workers must safeguard information learned in the context of their professional relationship and ensure information is shared outside the health team only with the patient's consent. Breaking the confidentiality without the consent of the client will destroy the relationship and also thwarts the purpose of the interaction”.

Let me relate to you two stories here and please take note that these are true stories because I knew the principal actors in both stories so they are not fiction as some of you may attempt to impugn after reading the stories. In the first case, this man I knew very well, caught the AIDS virus in the USA and decided to return to Ghana, to die in his hometown. He showed some symptoms of the disease but not so serious symptoms for the ordinary man to acknowledge. Upon his arrival at his hometown (Name withheld) he started receiving treatment from the local hospital so the nurses knew what he had but could not reveal it even to his closest relatives. Because this man had returned with goods and goodies, innocent young girls in the town were flogging in and out of this America- man’s apartment or house and he was very kind to them by giving them good reward after sex with them. Anecdotal evidence suggests that, this man may have had sex with as many as 20 unsuspecting young girls in the town, whilst the nurses in the town who knew that he was positive kept silent and watched in horror what this man was doing to those young girls and their boy friends. It was after his death that rumors started spreading that he died of AIDS. How many of those girls may have been infected by this selfish man? How many may have been infected by the girls through the chain reaction? Only God knows!!

In another case, I knew this man too myself; and he was a distance friend. He was working in Accra and his wife lived at their hometown (also name withheld) job and economic situation prevented them from seeing each other over a year, though the man was remitting his wife and children. I think (this is my personal opinion) that the long absence caused the man to have some sexual escapades with street girls and caught the virus. However, he felt sick and was admitted at the Korle Bu Teaching hospital (I even gave him $100 towards his hospital bills since I was in Ghana then). The length and short of it all is that, when his wife visited him at the hospital from her hometown, without the man’s consent, a caring nurse whispered into her ears that the husband had the killer virus and told the woman to take the test herself, which she did and found she was negative. That confirmed that the husband caught the virus possibly after their last encounter. She asked her husband repeatedly what was making him sick, every time, the answer was that it may be a curse that somebody has invoked on him. The woman cared for her husband but denied her sex any time he attempted until he passed away after 2 years. The surviving spouse is healthy and taking care of the 4 children they had together, some of whom are in college today, thanks to the nurse who broke all rules and revealed to the wife that her husband was HIV positive. She could have given in to sexual demands in those two years before his death.

Now considering these two real cases both of which I am privy to myself, and the selfishness of some Ghanaians who do not want to take it all alone, is it not better in the interest of preventing the spread of HIV-AIDS to make public persons infected so that the general public will take all the necessary precautions when dealing with such people? Why do we spare the rod and spoil the child? What will Ghana gain if she protects the dignity of a dying man only to have more people infected with HIV-AIDS? If one watches documentaries on the devastation of AIDS in the South African region (including Botswana, Angola, South Africa(where people believe that, if you are infected and you rape a virgin, you get cured, and so HIV positive guys are raping young girls left and right) and other countries. The numerous orphans being left behind to fend for themselves, it is incumbent upon us to act in a positive way to prevent a looming catastrophe that has the potential of affecting our national security.

This is just a food for thought, the debate must go on. Should we or should we not reveal the identities of HIV patients to protect society?Feature page

Views expressed by the author(s) do not necessarily reflect those of GhanaHomePage.

Columnist: Agyepong, Benjamin Opoku